State Prison Psychiatry

[franklinthedog]

What states are good for this? Can you get such a job with just a 4 year adult residency? Could you do this part-time? Isn't California the "best" state for this? What's the pay like? Do people doing this feel like they're making a difference, or is it just med mgmt with little pt interaction?

Thanks in advance...

---

Members don't see this ad.

 

[GatorMedMan]

I can't speak for Cali or for how rewarding it is, but there is a big demand in Florida. Many prisons around UF (north central Florida area) have offered UF graduating PGY4's positions, no fellowship required. The two figures I have heard are $1000 a day and $150 hour. I believe you would be working as an independent contractor, so I'm sure part time is possible.

 

[prominence]

do u need to get board certified within psychiatry for this type of work?

 

[Anasazi23]

Not usually, but they'll pay you more if you are.

 

[michaelrack]

There is a lot of locum tenens psychiatry work in the various state prison systems. I did it in Alabama for a week at a time (one week a month) for almost a year, while running a sleep lab in Mississippi the rest of the time.
Standard pay for locum tenens psychiatry is $75 per hour.

 

[goingbroke]

Does anyone know if this type of work has an increased malpractice rate? I read an interesting article that talked about prison psychiatry work. From the article, the work is considered higher risk than traditional psychiatry due to higher rates of suicide. Also, the article mentioned that limited medication formularies and possible poor staffing leave a psychiatrist open for additional liability. Any insights?

 

[Anasazi23]

Does anyone know if this type of work has an increased malpractice rate? I read an interesting article that talked about prison psychiatry work. From the article, the work is considered higher risk than traditional psychiatry due to higher rates of suicide. Also, the article mentioned that limited medication formularies and possible poor staffing leave a psychiatrist open for additional liability. Any insights?

I can only speak to where I work (Riker's Island).

Malpractice is paid for by the prison, or the company contracted to provide health care to the prison.

By the nature of the environment, population, and other factors, suicide is a higher risk. There is a 2 page stand-alone suicide assessment risk form that is completed and revisited on all inmates/patients. Jail suicides make the papers. The companies that contract to do this work don't like the bad press, and risk assessment for suicide in jails and prisons is important by default - it's a big deal there. I order a lot of COs (constant observations).

Medication formularies aren't too bad where I am. Jails and prisons are moving away or have already gone away from sedatives and other abuseable meds for obvious purposes. So, if a patient comes in on 600mg of quetiapine and I'm not allowed to give it, some prisons will allow it as a non-forumulary med, and some simply have you switch to another agent.

You're only as open to liability as your documentation. Do the right thing, order followups as often as you feel they're necessary, and document like a pro. Everyone in the jail is CYA'ing constantly. You have to do the same thing.

 

[goingbroke]

Thanks Anasazi 23 for your reply. I would imagine with the high rate of substance use in the jail population that alcohol, benzo, and opioid detox would be a major issue. I can just imagine a drunk driver sitting in his jail cell for his three day period when he starts to go into bad withdrawal or DTs. I remember one attending telling me the only time he was afraid that he was going to get sued was when he worked in a prison and a woman died from an opiate withdrawal complication. So even though people think that you can't die from opioid withdrawal it sure can happen. The situation is probably even more complicated by the fact that so many are drug seeking that one would be hestitant to prescribe and benzo or opioid. Also who is responsible for all the physicals and codes. The jail system seems like a place where one might be expected to do all the physician duties.

 

[TheWowEffect]

In my experience, many opioid dependent patients had their longest periods of sobriety while they were incarcerated. I wonder what is generally done for opioid depedence in prison/jail, as I'll be doing my rotation there in 4th year. May be they are just given some clonidine, imodium or something and then they can deal with it themselves. Residents at my program have moonlighted there and liked it, and I am thinking about it too.

 

[Anasazi23]

In my experience, many opioid dependent patients had their longest periods of sobriety while they were incarcerated.

Same here. Drugs are in the jails, but are in most cases much harder to get than on the street. These are often the only sober periods in a person's life.

I wonder what is generally done for opioid depedence in prison/jail, as I'll be doing my rotation there in 4th year. May be they are just given some clonidine, imodium or something and then they can deal with it themselves. Residents at my program have moonlighted there and liked it, and I am thinking about it too.

They give a methadone detox. Usually lasts about a week....then you have to deal on your own.

Codes and the like are practiced by medicine, and are not the psychiatrist's responsibility beyond in most cases...unless they code in front of your desk. Even then, it's just basic CPR until the medical team arrives.

I get a significant amount of disdain from the medical colleagues, mostly since they are constantly swamped at all hours of the night, while I get patients brought to me until the mental health clinic closes. There are nights where I have to go to the M.O. (mental observation) or "the bing" which is a whole other ball of wax, to do consults and follow-ups there, since they must remain in that confinement. Those nights have their advantages and disadvantages.

 

[TheWowEffect]

They give a methadone detox. Usually lasts about a week....then you have to deal on your own.

Good to know and I guess something is better than nothing.

 

[michaelrack]

I can just imagine a drunk driver sitting in his jail cell for his three day period when he starts to go into bad withdrawal or DTs. The jail system seems like a place where one might be expected to do all the physician duties.

My experience working in the Alabama prison system is that most inmates waited in a jail for at least several weeks before being sent more permanently to the prison. By the time inmates got to me in the prison, they usually already had been detoxed by the jail physician. This probably varies state to state.

 

[rednucleus]

The idea of doing some jail/prison wrok really interests me. It sounds too good to be true. What are some of the downsides? I would think that potential violence would be a concern. Also it only takes one paranoid homicidal inmate that becomes fixed on a psychiatrist that he feels has wronged him to cause some problems. Know of any psychiatrists getting attacked?

 

[michaelrack]

The idea of doing some jail/prison wrok really interests me. It sounds too good to be true. What are some of the downsides? I would think that potential violence would be a concern. Also it only takes one paranoid homicidal inmate that becomes fixed on a psychiatrist that he feels has wronged him to cause some problems. Know of any psychiatrists getting attacked?

I don't know of any psychiatrists being attacked, although my prison experience is limited. The most violent patients are usually seen when they're behind bars or in shackles. I always had the option of having a guard present when seeing inmates. I didn't have any problems with violence

the downsides are: lots of paperwork, salary (in general) lower than private practice, lots of downtime (some like this) when you are waiting for prisoners to get done with roll call, etc.

If you are still interested in prison psychiatry, I would advise you to explore it further by taking on some temp/locum tenens assignments before signing a long term contract.

 

[Anasazi23]

The idea of doing some jail/prison wrok really interests me. It sounds too good to be true. What are some of the downsides? I would think that potential violence would be a concern. Also it only takes one paranoid homicidal inmate that becomes fixed on a psychiatrist that he feels has wronged him to cause some problems. Know of any psychiatrists getting attacked?

The psychiatrist's interaction with these people are limited. They are seen by social workers and psychologists for more frequent visits and to do weekly treatment plan updates and paperwork. The psychiatrist sees them very briefly to check on meds and make changes q month, if necessary. If they're stable, they can go significantly longer before seeing the psychiatrist again. If the social worker/psychologist feels they need to be seen sooner, they request a followup.

Homicidal psychotic fixation is a remote possibility, but really more in the movies.

That said, it depends on the job capacity of the psychiatrist also...some are involved in testifying, giving professional opinions, or writing forensic reports. This is a different type of forensic animal, however, and is more specialty territory.

 

[Doowai]

I did a 4 week prison psyche elective in med school and liked it. There are things I saw as definate downsides and upsides. Downsides where I was included little control over your environment : waiting to get buzzed in through security gates, "secretaries" (prison gaurds) who interrupted any time they wanted, fear of everything being contaminated with hep C, occassionally having to wear stab vests, cinder block walls. Upsides included similar profiles with many of them (lots of mixed bipolars....go figger), decent hours,no call.

Suicides were a trip. One guy on a suicide watch almost killed himself with a spork (one of those plastic fork/spoon combinations) - only about 1/4 of an inch was sticking out of his abdomen, was very close to his abd aorta. How he got the spork nobody is sure. One guy used baby fingernail clippers to snip off all his junk, he was laying in a blood pool and his junk was over in the corner. Wow.

I was in a max security facility (5/5 rating). Very few homocidal guys. Mostly personal drug use (meth). Some of the girls were scarey. One girl who set her little brother on fire among other things - and when we would mention it she would just giggle. One girl was involved in making slash/snuff films - actual films of rape and then they murder the girl on film. Girls are wwaaaayyyyyyy scarier than guys - just like outside the pen. If someone googles my real name pages of information shows up - I was afraid that an inmate would google my name and know all about me and where to find me.

Lots of serious rules. If you let a writing pen get in the hands of an inmate and they do something like make a tatoo with it you can suffer serious legal consequences.